Internationally, obstetric anesthesia guidelines recommend spinal and epidural over general anesthesia for most cesarean sections. This work is done to assess the development of respiratory depression in neonates delivered under general & spinal anesthesia during elective cesarean section to confirm which anesthesia type is better as regards fetal outcome in elective cesarean section. Patients and methods: This is a prospective randomized study involving 200 women with a singleton full term pregnancy divided into two groups according to anesthesia type, who underwent elective cesarean section in Kasr Al-Aini Maternity Hospital. The main outcome measure is to compare the development of neonatal respiratory distress after elective cesarean section with different anesthesia techniques using Silverman Anderson retraction, Downes' score and Apgar score at 1 and 5 minutes. Also the aim is to detect neonatal admission to ICU, neonatal birth weight as well as cord sample gas analysis to detect development of acidemia in the delivered neonates. Results: The incidence of neonatal respiratory distress and NICU admission occurred more often with the use of general compared to spinal anesthesia in elective cesarean sections. Conclusion and recommendations: Using spinal anesthesia is recommended for elective cesarean sections provided that adequate maternal hydration is established and sparing general anesthesia for emergency cesarean sections or whenever spinal anesthesia is contraindicated.